Pathological Vital Signs Flashcards
what are the categories of acute coronary syndrome
unstable angina
MI
- STEMI
- NSTEMI
explain difference between STEMI and NSTEMI in relation to location/degree of infarct
ST = st elevation MI resultant from total occlusion thrombus
NST - non-st elevation resultant from partial occlusion with or w/o collateral circulation
if ventricular chamber dilates, what occurs to
- heart wall
- blood pressure
- vasomotor tone
wall thins and systolic function decreases
decreased CO = hypotension
vasoconstriction and afterload increase = greater ischmemia
what does nitroglycerin act as?
vasodilator
why may tachycardia occur during acute coronary syndrome
vasoconstriction
decreased CO
HR increases as a response
what is the associated elevation of ST segment during STEMI
1 mm
what elevated markers indicate necrosis
troponin I
troponin T
creatine-kinase MB
for patients with stable ACS/MI patients, what values indicate ability to do PT
RR <30 breaths per minute
<120 RHR
MAP of at least 60
SpO2 >90%
SBP <110 mmHg
indication to stop PT intervention in those with ACS / MI
unable to comfortably speak
RR >40 breath/min
onset of S3 heart sound
HR decrease of >10bpm
SBP decrease of >10mmHg
MAP increase >10mmHg
SpO2 <90% of decrease greater than 4% from baseline
return of pre-MI angina pain
HFpEF
- value
- indicates which dysfunction
55-75% ejection fraction
diastolic dysfunction
HFrEF
- value
- indicates which dysfunction
EF <40%
systolic dysfunction
BP equation
CO x TPR
what may increase in those with HFrEF
increased RR due to pulmonary edema
for those with stable HF, what vitals indicate PT
RR <30 breath/min
crackles below rib 5 posteriorly
resting HR <120
MAP >60mmHg
minimal/no weight gain in 24 hours
for those with stable HF, what vitals during PT indicate stoppage
unable to comfortably speak
RR >40
S3 heart sound onset
pulmonary crackles above rib5 posteriorly
HR decrease >10
SBP decrease >10mmHg
MAP increase > 10 mmHg
new onset/worsening cardiac arryhtmia
what can be visually monitored in those with Right Sided HF
jugular vein distension
peripheral edema
what can cause claudication
O2 demand > O2 availability in periphery
what is the measure of ABI? what values indicate what?
ankle SBP / arm SBP
<0.9 suggests PAD
>1.1 suggests atherosclerosis / DM2
what is commonly found in those with PAD
other CVD
what can be important to screen for in those with PAD? why these things?
fall risk / integ changes
- blood obstruction can lead to muscle atrophy/decreased endurance
s/s of CVD (50% of those with PAD have a form of another CVD)
what commonly causes aorta aneurysms
atherosclerosis and systolic HTN
what defines an aortic aneurysm
dilation of aorta
>50% of orignal size
or
> 3 cm
what are the common vital sign indicators of aortic aneurysms
tachycardia
decrease BP
– especially with complain of sudden abdominal pain
DVT s/s
pain
ipsilateral swelling
warmth or redness
– most common in the LE
pulmonary embolism s/s
unexplained shortness of breath
decreased SpO2
pleuritic chest pain
cough
tachycardia
what are marked in both types of lung disorders
progressive dyspnea
hypoxia
decline FEV1
what is the diagnostic threshold for RLD
FEV1/FVC = >85%
explain difference between primary and secondary RLD
primary = within the lung, issue that is specific to lung tissue
secondary = condition that could limit thoracic expansion
what is under the umbrella of primary RLD
pneumonia
interstitial lung disease
acute lung injury
acute respiratory distress syndrome
what is the appearence of those with RLD
emaciated
kyphoscolosis
tachypnea/tachycardia
explain minute ventilation changes in those with RLD? any considerations?
will decrease to 1:1
- more so RR than tidal vol reserve
will need supplemental O2
for those with RLD, what vitals indicate PT
RR <40 breath/min
HR: 60-120
SpO2: >90%
what vitals indicate stoppage/modification of PT in those with RLD
unable to comfortably speak
SpO2 <85%, especially if on O2
decrease in HR and SBP by >10 units
what can be helpful early on in RLD intervention vs what is not?
inspiratory muscle training
“deep slow breaths”
– need to increase RR because they are limited in thoracic expansion ability
what is the diagnostic threshold for OLD
FEV1/FVC <70%
what is under the umbrella of COPD
chronic bronchitis
emphysema
bronchiectasis
asthma
cystic fibrosis
explain respiration ratio in those with OLD
will move closer to 1:3 or 1:5
- normal is 1:2
explain oxygen supplmentation in those with COPD
it is something to be careful of in chronic patients
- those with COPD rely on hypoxic drive for breathing, therefore more O2 in the system can disrupt that
what vital signs indicate PT in those with OLD
RR <30 breath/min, speaking comfortable
SpO2: >90% at rest (+/- O2 supplement)
HR: 60-120 bpm
what vital signs indicate PT stoppage/modification in those with OLD
inability to comfortably speak
SpO2: <85%, especially with O2 supplement
HR and/or SBP: decrease of >10 units
what level on the BORG are we looking to get pts with RLD/OLD to in treatment
11-13 on 6-20 scale
for those with DM, what is important to monitor in relation to HR
dysrhythmias / atrial fibrillation
for those with DM, what is important to monitor in relation to BP
orthostatic hypotension
explain pulse oximetry measurements in those with DM
may overestimate O2 saturation in those with poorly managed DM2
- ABG may be needed
level of pre-exercise blood glucose
90-250 mg/dL
what symptoms may indicate silent ischemia in those with DM
fatigue
nausea / vomiting
sweating
dyspnea
arrythmia
what to do if pre-exercise blood glucose is:
low (<90 mg/dL)
vs
elevated (250-350 mg/dL)
vs
high (>350 mg/dL)
low: ingest 15-30g of carbohydrate
elevated: test for ketones
- if negative, low mild to moderate is indicated
- if positive (mod to large amounts) no exercise
high: no exercise
in those with chronic DM, what is often found? how can this affect vital signs?
autonomic neuropathy
increased resting HR (early stages) then fixed and unresponsive during exercise
